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<br />APPLlCAT1011 POR "PUMlT <br />CITY or ZIPHDJIIUS <br />BUILDING DEPAfl11lDT <br /> <br />i <br />I <br />I <br />I <br />I <br /> <br />OWNER'S IIAII& (5~~ ~ -' ..:j;"nC- <br /> <br />OWIID'S ADDII8S __ 7 5sS- (;..f1L~ t/ ~/ 1:1 z~ <br />? f?_. ( <br />JOB AoDRBSS 2 ~ CJ b fJ'TV LL b/JN~ <br /> <br />8'/> - 7y-> - f?'//~ <br />PHON&: ~ /, ~ <br />/'t'/}JJ'f~;/I.J, rL. 3~s 9/ <br />v \l ,/ <br /> <br />LBcAL DISCUPlIOX, LOT(S) IlLOCIC, SUBDIVISION <br />PARCEL I.D.' (OBTAD FROII PlIO"'" JjllU)TICRl <br />wmut PltOPOSID :..0- Coaatructtou ~ltloo ..--.Alteration . -.Jlepair ~ll8tall <br />.;,6ilPl --Jfove ~l18h <br />ftmmSU_I: ---ft~ler_i~ _"/F _' of Units --lI/B <br />~co.erCl.J. _ladust. -5wia. Pool _Other <br /> <br />---Reataurant . Health Departllent Approval <br />DBSCUPTIOl or WOK: Ch;<lr}/Jd. L~7~f ~ @d). <br /> <br />IUlLDIJO SUI: <br /> <br />x <br /> <br />Square Feet, <br /> <br />Betsht <br /> <br />, <br />, . RBSlDBIT1AL: ATTACR (2) not PLARS Ii (2) saTS or BUILDINC PLANS , (1)SBT B"BRGY FORKS. <br />cotItDCL\L: AftACB (3) SITS or BUll.DlIiG PLANS Ii (1) SIT BNBRCY FORIIS. <br />PROlan stJavn UQUUID FOa ALL NEW CONSTRUCTION. <br /> <br />PP..RMlt~ J~~~1RD <br /> <br />, I <br />" , <br />, . <br />, <br /> <br />~BUlLDUG <br />, --..J~GAL <br />,~CAL <br />, ' <br /> <br />~IIC <br /> <br />s (1 () lJ D (1) <br /> <br />Valuation of Total conatruction <br /> <br />AIIP Servtce <br /> <br />Plorida Power COrp~ <br /> <br />W.R.B.C. <br /> <br />. <br /> <br />Valuation of lledwutcal l~tai1atioD <br /> <br />I I I <br /> <br />GAS <br /> <br />ROOPtIC <br /> <br />SPBcw.n <br /> <br />II, <br /> <br />" , <br /> <br />TuB or cmsuucTIOI: ',____lock <br />I <br /> <br />_Fraae ~teel <br /> <br />Other <br /> <br />, <br /> <br />, 'I', <br /> <br />. , <br />nus... n.oOa a.lVAUOIISt <br /> <br />"' . IS PROJECT 1. FLOOD ZOIlE ADAt <br /> <br />TIS NO <br /> <br />.......................................... <br /> <br />poRTUCTOR SECTIOII <br /> <br />..."...nll <br /> <br />Slpatue <br /> <br />OOKPAIY <br />State Cert. or Ile,tlt. . <br />City Lieeose Re,istration . <br />.......................................... <br /> <br />n.RC'l'aIf!'IA. <br /> <br />StllllUltu~. <br /> <br />COMPAIY <br />State Cert. or &ealst. . <br />City License leatatration . <br />.......................................... <br /> <br />Sipature <br /> <br />COKPAllY <br />State Cert. or Ileaist. . <br />City Ltceaae ReSiatration . H <br />.......................................... <br /> <br />PLlllBER <br /> <br />T1U <br /> <br />IIInIAIII ,....,. <br /> <br />8taDature <br /> <br />COMPANY <br />State Cert. or Ileal't. . <br />Oity Lieeoae aeatstration . <br />.......................................... <br />~ - ( <br />, COMPAIfY ~~ ~~ <br />;?.A~ -1 ~ State Clert. or KeSlat. .' ,t;J on Of'> /18 <br />7f City License Reatstration' <br />.. . .................................... <br /> <br />OTIIKII <br /> <br />Sl....ture <br /> <br />APPLICATION APPROVBD BY <br /> <br />PBRKlT OFrICD. <br />